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Surgical Treatment for Acromegaly

Transsphenoidal surgery is an invasive procedure performed to remove pituitary tumours. This surgery relieves pressure on the brain regions surrounding the tumour and reduces GH levels. If the surgery is successful, the patient's facial appearance and soft tissue swelling improve within a few days. Surgery is most successful in patients who have pituitary tumours no larger than 10 mm in diameter. The expertise of the pituitary surgeon is also extremely important for successful surgical management, with the highest success rates coming from surgeons who conduct at least 50 pituitary procedures a year. The best measures of surgical success are normal levels of GH and IGF-1. A GH level of less than 1 µg/L after an oral glucose load is ideal.1-5

Transsphenoidal surgery for acromegaly Beckers A. Transsphenoidal surgery. Pituitary Adenomas. An Interactive Resource for Your Library. Basel: Novartis Pharma AG; 2001.6

Potential complications of transsphenoidal surgery2,4:

  • Damage to surrounding normal pituitary tissue, requiring lifelong pituitary hormone replacement
  • Cerebrospinal fluid leaks
  • Meningitis

Even after successful surgery and normalisation of hormone levels, patients should be monitored closely for possible recurrence as part of patients’ lifelong, routine, follow-up plan. More commonly, hormone levels will improve, but they may not return to normal. Additional treatment, usually with drug therapy, may be required.

References: 1. Melmed S, Casanueva FF, Cavagnini F, et al; for the Acromegaly Treatment Consensus Workshop Participants. Guidelines for acromegaly management. J Clin Endocrinol Metab. 2002;87:4054-4058. 2. AACE Acromegaly Guidelines Task Force. American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for the Diagnosis and Treatment of Acromegaly. Endocr Pract. 2004;10:213-225. 3. Giustina A, Barkan A, Casanueva FF, et al. Criteria for cure of acromegaly: a consensus statement. J Clin Endocrinol Metab. 2000;85:526-529. 4. Melmed S. Medical progress: acromegaly. N Engl J Med. 2006;355:2558-2573. 5. Melmed S, Colao A, Barkan A, et al. Guidelines for acromegaly management: an update. J Clin Endocrinol Metab. 2009;94:1509-1517. 6. Data on file, Novartis Pharma AG.


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